Associate Director, Quality and Compliance, DentaQuest (California)

Sun Life•Laguna Hills, CA

21h

About The Position

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide. Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities. DentaQuest manages dental and vision benefits for more than 33 million Americans. Our outcomes-based, cost-effective solutions are designed for Medicaid and CHIP, Medicare Advantage, small and large businesses, and individuals. With a focus on prevention and value, we aim to make quality care accessible to improve the oral health of all. Job Description: Location: Must reside in California The opportunity: The Associate Director, Quality and Compliance provides operational guidance in the effective delivery of services to clients, members, and stakeholders. Through partnership with operational team leads, the Associate Director collaborates on service delivery, corporate and division strategic priorities and compliance with implementation of all regulatory requirements, including but not limited to quality, fraud, waste and abuse, diversity, equity and inclusion, and civil rights. This position reports to the director within the Compliance department. This position handles contractual and regulatory quality and compliance for California government program clients. In addition, this position serves as the compliance subject matter expert (SME) to the operational leads in implementation of contractually and regulatorily compliant processes. Administers an organizational quality management system and monitors progress against strategic and contractual quality-related goals.

Requirements

Five years’ experience in government programs product management, regulatory affairs, operations or other similar healthcare related government programs function preferably in health care/managed care environment
Up-to-date knowledge of state and federal laws and regulations, including Medicare/Medicare Advantage and Medicaid requirements
Proven ability to influence cross-functional teams without formal authority, including skills in collaborating and influencing others
Excellent communication skills (verbal, written and presentation) required for formal reports and updates
Ability to read statutes and regulations and interpret them in order to identify compliance needs/risks, etc.
Attend additional training as requested/deemed necessary
Reasoning skills to interpret, predict and improve process and performance creations and analytic skills of Charts and Graphs
Attention to detail
Strong verbal and written communication skills
Strong knowledge of Microsoft Office Systems

Nice To Haves

California Regulatory knowledge, preferred

Responsibilities

Serves as quality and compliance contact and is responsible for overall compliance with contractual, federal, state and local laws, rules and regulations affecting California Quality and Compliance programs.
Monitor, research federal and state regulations and proposed regulations to identify applicability for Company and works with Government Relations and Legal to ensure appropriate application of laws and regulations
Develops training programs to ensure DentaQuest is meeting its legal and contractual obligations
Coordinates and communicates to internal departments and external clients and vendors, where appropriate, all compliance activities and programs, as well as integrates the California Compliance and Quality Programs into the Company’s Compliance Program and Workplan
Maintain up-to-date knowledge of developments in all legislative and regulatory implications for DentaQuest California.
Oversees the operational aspects of California compliance and Quality, working closely with leadership in operational areas to provide audit and monitoring oversight, as well as information to ensure they know regulatory and contractual requirements.
Assists operational departments with review of policies and procedures designed to ensure compliance with contract obligations and other applicable requirements
Develops policies and procedures to ensure DentaQuest’s Operations in is compliance and assists with the development of policies and procedures specific to operational areas
Assist account/operational management in responding to health plan and DHCS audits and provide technical assistance to improve performance, as needed and requested
Oversees implementation of initiatives associated with contractual operational compliance and quality and drives to completion

Benefits

At our company, we are committed to pay transparency and equity.
The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable.
Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location.
In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business.
We are dedicated to creating a work environment where everyone is rewarded for their contributions.
We are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive.
We are dedicated to building teams with varied experiences, backgrounds, perspectives and ideas that benefit our colleagues, clients, and the communities where we operate.
We encourage applications from qualified individuals from all backgrounds.
At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program.
Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account.
Enjoy a flexible, inclusive and collaborative work environment that supports career growth.
We’re proud to be recognized in our communities as a top employer.
Proudly Great Place to Work® Certified in Canada and the U.S., we’ve also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row.